Cupping

Cupping for Myofascial PainThanks to Olympic Gold Medalist Michael Phelps’ massive performances in the Rio Olympics while covered in purple cupping marks, the art of Cupping for Pain and in Sports Medicine has received a lot of buzz (see NY Times Wellness Blog Article on Cupping).

I use cupping for pain and in Sports Medicine every week, and find it an excellent adjunct treatment for myo-fascial pain disorders, including trigger point pain, tight painful muscles in the neck, upper, mid and lower backs, and in the kind of tight congested muscle that athletes like runners and bicyclists get in their hamstrings, quadraceps, and calves.

Cupping Therapy for Colds

Originally cups (cups are the glass or plastic devices used to do “cupping”) were, and continue to be, used, in both Chinese Medicine and in the home remedies of many cultures, especially Slavic and Middle Eastern ones, to relieve symptoms of colds, fatigue, and depression. When using cupping for colds it is best to use them at the first sings of chills and sniffles, another words, when you are first coming down with a cold, what Chinese Medicine terms “invasion of Wind-Cold, or Wind-Heat.” The idea here is that the cups pull the “wind” out of the body, which has what people nowadays would call a detoxification and immune stimulating effect.

How Does Cupping Work for Myofascial Pain and Sports Medicine

In the case of cupping for sore, tight, painful muscles, if you want to think in terms of toxins, you may, in that what the cups do physiologically in scientific terms is rupture the capillaries under the skin in the fascia. This is good, because now the body can metabolize all the toxic inflammation causing lactic acid that has built up in tight, tense, sore, overused muscles and fascia, and rush new blood in rich in nutrients.

Another way to explain how cupping works for pain is that it breaks up adhesions in the fascia, the tissue that adheres the skin to the underlying tissue (think about when you pull the skin off a chicken leg). In a way our bodies are like big spider webs of fascia around which everything else is organized. Out internal organs, for instance, are held in place by both suspensatory ligaments and by webs and sheaths of fascia. That is the basis of a therapeutic practice called visceral manipulation. Our muscles especially are organized by a mesh of fascia that contracts and expands when the muscle does.

Adhesions of the fascia in the muscles are often formed around trigger points and motor points; an example would be the big lumps we get at the top of our shoulders. I don’t know about anyone else, but i did not have those when i was young. I remember when i first started noticing those, it was after four years of typing papers in college with bad ergonomics, and also high levels of stress combined with being 34 and not 24.

When To Use Cupping

Often when people come in with very very tight muscles, or when I see people that don’t tolerate deep needling, or when they come in with really tight rhomboids, the muscles between the shoulder blades/scapula and the spine, which is dangerous to needle because of the closeness of the Lungs to the surface (you can needle at a horizontal angle, towards the scapula, and also tight to the vertebrae, in the Hua To point area, but still there are points between that are difficult to get) or again, the large muscles of the legs, I love doing cupping. It is so effective and gives such relief of pain.

Chinese Medicine on Cupping Therapy for Pain: Open the Flow of Qi

But in Chinese Medicine what we have to say about cupping and acupuncture for pain is quite simple: “Where there is pain, there is stagnation of Qi, and where there is stagnation of Qi, there will be pain.” This is from the classics. To my opinion, the most effective way to practice acupuncture and Chinese medicine, or at least the first thing you must learn, is how Chinese Medicine itself thinks. What cupping, like acupuncture, does, fundamentally, is to move stagnation of Qi.

Key Point: In Chinese Medicine we use cupping and sliding cupping to open up the flow of Qi through the tendino-muscular channels, through the main channels, and through the skin and underlying fascia.

The tree that bends does not break, and when the Qi flows well our body’s and minds remain flexible and youthful. This goes for being open minded, creative, and improvisatory, as well.

For example. My friend was helping me apply acoustic tile to the ceiling in my office to reduce the echo of sound off of the tile floor. I was suggesting we use a method for applying the tile that was not the regular method. She looked tense and anxious, and, kind of got angry at me, saying -“the guy at Home Depot said that is not the correct way.” Well of course it wasn’t, but the problem was the correct way was un-doable in our case. I had to suggest she relax and be open to alternate methods. Necessity is the mother of invention. Mechanics in Cuba have kept American cars from the 40’s running until now and its not with parts made in Detroit.

The Mind Leads the Qi: Open Its Flow By Staying Calm and Relaxed

What struck me was just how tense my friend looked at the prospect of working outside the box. She is also my patient, and she has chronic back and shoulder pain from tight muscles that are the result of severe, chronic mental tension and not bad ergonomics. She is, by her own description on “red alert” at all times. For her chronic back and shoulder pain from tight muscles Cupping is a great technique, because it opens up Qi flow. If however, she learned to relax though Yoga or meditation, rather than that daily glass of red wine, she would need cupping and acupuncture much less frequently.

Cupping Therapy with Acupuncture

Most of the time I use cupping in conjunction with either Classical Chinese Acupuncture, or Dry Needling Therapy, because cupping works better when it follows acupuncture or dry needling. That’s because acupuncture and dry needling release the trigger points and motor points which allows the muscles and fascia to lengthen, so now they are more “open” to the benefits of cupping or massage. And on the other hand, as I said earlier, when I treat pain conditions or Sport’s injuries involving tightened fascia or muscles, cupping potentiates the effects of the acupuncture treatment by acting as physical medicine, breaking up adhesions and forcing new blood into the area.

Cupping Therapy with TDP Heat Lamp

When I use stationary cups in which I apply the cups and leave them be for anywhere from 2 to 15 minutes, often with the additional assistance of a TDP long range infrared heat lamp. For more info on TDP heat lamp therapy.

The TDP lamp is a special kind of heat lamp with a mineral plate developed by Chinese Medicine researchers that uses a special mineral rich heating plate that emits a very deep and soothing quality of heat, similar to the effect of burning mugwort used in Moxabustion. This increases microcirculation and loosens fascia.

Cupping with Medicinal PlastersI frequently follow this combination of acupuncture, cupping, and heat therapy, with the application of a very specific Chinese Medicine Pain Relieving Medicated Plaster. The brands that my patients love best is the Golden Sunshine Brand Pain Terminator Patch PT-103. WARNING: The reason I use this kind of plaster is because a) it is latex free, and b) because its safe to use after mild heat. IF YOU HAVE SENSITIVE SKIN, ARE ALLERGIC TO LATEX, OR BURN EASILY, DO NOT USE A PLASTER AFTER THE TDP LAMP OR ANY OTHER KIND OF HEAT, SO AS TO AVOID BURNING YOUR SKIN.

A plaster is like a large band-aid that is coated in Chinese Herbs that reduce pain, improve circulation, and create the feeling of heat. The advantage of the Golden Sunshine brand is it contains some kind of interesting piezo-electric powder this is activated by your body’s own heat and that emits a long wave heating effect. This brand also does not contain latex, and, while it has a strong menthol type odor, is not so strong as to burn your skin, unless you have super sensitive skin. All plasters, like Ben Gay or Tiger Balm, act as a counter irritant that improves circulation to an area and are especially valuable for muscular and fascial pain. I like plasters more than lotions or liniments, because they last much longer and have a much deeper, long lasting, effect. I have people leave them on till the following morning after the treatment. WARNING: Do NOT combine plasters with heating pads, hot showers, or hot bugs.

Qi Stagnation, Heat Therapy, and Cupping in Chinese Medicine

When our Qi stagnates, whether due to traumatic injury or due to stress, our muscles tighten, and when muscles tighten that means they have shortened. Worse, is that tight muscles are actually working non-stop, and become fatigued. When fatigued muscles work they have to get their energy needs from an-aerobic instead of aerobic respiration. The problem is that an-aerobic respiration has as its waste product lactic acid. And Lactic Acid over time forms crystals that in turn irritate the fascia and muscles, leading to fibrositic nodules and adhesions.

Muscles work by shortening and lengthening. You touch your nose with your index finger and your biceps has just shortened. Its a system of levers, actually. Bring your hand to your side and your biceps has lengthened again, no worries. But touch your nose 100 times, or do strength training, and your biceps will be left shortened. That is why its so important to stretch after exercise, to restore your fascia and muscles to their proper length. And heat after exercise increases the blood flow to remove lactic acid and other toxins from the tissues.

The problem is that when you are stressed out, when your Qi stagnates, (or when your Pitta or Vatta are elevated in Ayurvedic terms) your muscles and fascia, thanks to the effects of the hormones produced by the fight or flight response, are left shortened and full of irritating lactic acid crystals. Chronic stress leads to chronic shortened muscles and fascia, which, especially if you then have bad posture or do repetitive tasks like typing, then become painful.

Cupping is an excellent method for tight, painful, shortened muscles due to stress and bad posture, because because cupping therapy radically moves the Qi in the tight muscles, breaks up adhesions, and improves blood circulatin to flush out those toxic lactic acid crystals. And Cupping causes the muscles to open and relax. In fact most people find cupping very pleasurable, like deep tissue massage. Being open is associated with relaxation and pain relief. Again you see human psychology. When we describe someone as open hearted, or just open to new things, do you get the sense of someone more or less tense than average? Tension is the enemy that makes you into a stiff tree that can’t bend with the wind. That is why bamboo, not redwoods or oaks, are the model from strength in Chinese culture. Bamboo goes with the flow; it bends, it does not break. Sometimes you have to fight, but not always.

Sliding Cups vs. Stationary CupsSometimes I like to use the method called “sliding cups”. For more info on sliding cups

Once I have unblocked stagnation with needles and stationary cups, then i like to use “sliding cups.” When I use stationary cups that dont slide, let’s call that dry cupping, I usually apply a Chinese Medical plaster afterwards. This is like a large band aid, if will, impregnated with Chinese Herbs that have an anti-inflammatory, blood circulating, analgesic pain relieving effect. The best brand is the one i get from Blue Poppy Herbs, which even has a piezo electric ingredient that applies long range infrared heat in addition to the chemical effect of the herbs.

When I progress to the sliding cups, I like to first apply a Chinese liniment, like Dr. Shir’s Liniment or an Ayurvedic oil, like Mahanarayana Thailam, which is used traditionally for Sports Injury and Arthritis, and also for prevention, the best quality I have find is from Oilbath.com, or Dabur Brand and sometimes I put on the alcohol based Chinese liniment first, followed by the oil. Sometimes I skip that step and just use Coconut Oil or Cocoa Butter. In both cases I use some kind of oil that allows the cups to slide along the skin, pulling it away from the muscles, kind of the opposite of what happens when you press on a muscle. This seems to really break up adhesions in the fascia and works great everywhere. I use it for IT Band pain, hip, leg, calf pain, tendonitis of the forearm, tennis elbow, and all kinds of back and shoulder pain, its great for the rotator cuff pain, too, and frozen shoulder. This is so so much better than dulling your pain with toxic drugs like Vicodin that dont work and don’t address the actual cause of the pain.

If you have any questions about the treatment of your pain condition with Classical Chinese Acupuncture and Cupping, please let me know! Thanks

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